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Archive for September, 2012

Just released on September 21, Hysteria is a light comedy about a dark and silly time. So touchy is its topic, in fact, that it took the producer, who is a woman, about ten years to find a studio willing to back the project. So unnerving is the topic that the author of the book on which the movie is based, who is also a woman, lost her job as an assistant professor when it was published.

Hysteria, the movie, and the book, titled The Technology of Orgasm by Rachel Maines, explore the modern history of the vibrator. And a surprising story it is. The movie, which stars Maggie Gyllenhaal and Hugh Dancy, approaches the topic with a comedic touch. It is described by Movieline.com as “spirited, a jaunty trifle that’s low on eroticism but high on cartoony coquettishness.”

But beneath the silliness—because, really, how else can this be portrayed?—lies the basically true story of the invention of the vibrator. The unnerving truth may be that the paternalistic and harebrained notions that led to the invention of the vibrator continue to entangle themselves in our “modern” cultural psyche. The movie, but more insistently the book, raises some instructive and faintly unsavory questions about embedded cultural expectations regarding women and sex.

First, we’ll look at the vibrator story, and then, in a future post, we’ll explore the cultural attitudes lurking beneath.

If you’ve ever read novels from the late 1800s—the Victorian period in England—such as those by Jane Austen or the Brontë sisters or Edith Wharton in New York, you may have noticed a certain… reticence… a naiveté, an innocence about sexual matters. “Making love” in these novels refers to the most innocuous verbal expressions of admiration. Respectable women were corseted, cosseted, and shielded from turbulence of any sort. The preoccupation of a young woman was to attract a suitable match, and having done so, she was to run an efficient household and be an asset to her husband. Little was heard of her henceforth.

Having read many of these novels, I’ve often wondered how children were ever conceived.

So I was amazed to discover that these same respectable Victorian women were prescribed a very unusual medical procedure by their doctors to alleviate emotional afflictions, which were diagnosed generally as “hysteria” or “neurasthenia.” Symptoms ranged from anxiety and nervousness to headache and sleeping difficulty to abdominal “heaviness.”

A procedure that seemed to temporarily relieve these symptoms was known as a “pelvic finger massage,” typically administered by those very proper doctors. The goal of this treatment was to induce a “hysterical paroxysm.”

So—to put it in contemporary terms—doctors were masturbating their female patients to orgasm in order to relieve the sexual (and other) frustrations that women in this era commonly experienced. And this in a culture that viewed a glimpse of ankle as risqué.

“It’s very difficult to imagine that 100 years ago women didn’t have the vote, yet they were going to a doctor’s office to get masturbated,” said Gyllenhaal in an interview with the UK’s Guardian.

At the time, however, the procedure wasn’t thought to be sexual. In fact, doctors considered it routine, tedious, and boring.

“Annoyed doctors complained that it took women forever to achieve this relief,” writes Eric Loomis in “The Strange, Fascinating History of the Vibrator.” Yet, since repeat business was virtually assured, doctors weren’t complaining about the steady income.

So, they invented a machine to do it for them. Thus the vibrator was born.

Early models ranged from comic to frightening. A steam-powered vibrator called the Manipulator, invented by an American doctor in 1869, required the patient to lie on a table with a cutout at the business end. A moving rod was powered by the steam engine in another room.

Lack of mobility was a problem with this contraption—a doctor was committed to a large, stationary object that consumed two rooms. And if the engine was coal-powered, who did the shoveling?

The next model was electric, and the battery only weighed 40 pounds. This was developed by Dr. J. Mortimer Granville, our erstwhile hero in the movie Hysteria. So it was that the vibrator predated the invention of the vacuum cleaner or the electric iron by over a decade. I ask you, where are our priorities, ladies?

Despite their size and lack of attention to attractive design, the things worked. From over an hour of manual manipulation, a woman could now reach “paroxysm” in five minutes.

But progress marches on, and by the turn of the last century, more domestic households had electricity, and vibrators had become small, portable, and widely available. Reputable magazines and catalogs sold them alongside the toaster and the eggbeater. A woman could buy a “massager” for what a few visits to the doctor cost, and thus the medical profession lost its cash cow.

Advertisements in magazines like Women’s Home Companion, Sears & Roebuck, and Good Housekeeping promised that “all the pleasures of youth… will throb within you” and “it can be applied more rapidly, uniformly and deeply than by hand and for as long a period as may be desired.”

It beggars the imagination to believe that no one through all these decades considered that massaging a woman’s genitals had anything to do with sex. And in fact, the Guardian article states, “Despite the lack of evidence to suggest otherwise, it seems unlikely [that women really did not know what they were buying]–and the manufacturers surely knew what they were selling.”

This level of schizophrenia is the vexing conundrum at the heart of the vibrator phenomenon.

In a future post, we’ll explore the more recent history of the vibrator and the questions suggested by this massive blind spot.

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I hear from a number of women that although they’re in long-term relationships, they’re feeling alone. Sometimes this becomes apparent as part of adjusting to other changes—like sending the last kid off to college, welcoming a parent into the household, or adapting when one or both partners retire from a career. I asked MiddlesexMD advisor Mary Jo Rapini, a psychotherapist who specializes in intimacy and relationships, what women can do when they find themselves unsatisfied.

The loneliest feeling doesn’t come from being single. It’s being married or living with someone, but feeling alone. This happens when one of the partners checks out emotionally but eats there, does their laundry there, and sleeps there. For all other purposes, though, there is no partnership. This happens to couples who live together as well as couples who date and marry. Many times some type of crisis precipitates a partner’s emotional distance, but sometimes it just happens. You may sense your partner no longer values your judgment. You may notice your partner no longer listens to you, talks to you, or wants to engage with you.

When a woman first begins to feel lonely in her relationship, she doesn’t automatically get help. She’ll usually try to understand what is going on in her partner’s life. She may ask, “You okay?” or “What’s the matter?” Those questions are usually answered by, “Oh, just work,” or, “I’m just tired.”

Sometimes the partner will come back with, “Nothing I say is good enough, and you fight me on everything.” When this happens, the partner who asked the question begins feeling even more alone and more stuck in her loneliness. They may reach out to friends or family, or begin reading self-help books. Her friends may validate that her partner is cruel, insecure, having an affair, or all of the other things friends try to do to make one feel better. The bottom line is, she’s in a bad position. She is committed to someone and very much alone.

The amount of distance in a relationship is determined by the couple and the style they develop. Many of us like more distance between ourselves and others, and this is reflected in how we relate. Just as some people are very private and others extremely open; some couples cannot go to the grocery store without the other, and some travel across the world without each other. It’s a personal preference; neither is right or wrong.

Feeling alone is much different than actually being alone. Feeling alone means the communication is broken. Your partner may be in Africa and you in Texas, but if you are talking on the phone and sending silly texts or emails, you’re together. If he is at your side, but no longer engaging with you, talking to you, wanting to be with you, he might as well be in Africa.

As with most things, this emotional distance is easier to prevent than to fix once the damage is done. But here are three steps to take to feel less isolated in your relationship:

  1. Ask yourself if you really want this relationship. Sometimes we become lonely when we long for someone or something else. Your partner may sense that you’re not communicating that you feel stagnant or want out. Your partner may be withdrawing as a way of limiting—or pre-empting—the hurt.
  2. Talk to your partner about how you feel. Does your partner know you feel unloved or distant? No one can read your mind. It’s possible that your partner is feeling the same distance and will welcome you raising the issue.
  3. Are your beliefs about money, sex, or faith getting in the way of your need to be connected with one another? Couples who are fighting may project the anger from the disagreement onto the relationship. The distance created is actually about disagreeing over a topic. If you talk about this, it will help bridge the distance you feel.

Our relationships are a way to receive—and to give—the love, acceptance, and security we need to grow and evolve. To be physically and emotionally alone in a committed relationship is unbearable because the hope of connection is lost. Study after study has shown what happens to babies who are isolated from human love, acceptance, and security. We never outgrow that need.

If you still feel stuck, get help. Couples therapy has helped thousands of people reconnect. And if your partner isn’t interested, a trained, objective counselor can help you to evaluate where you really are and what your options might be.

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Last week I wrote about the STRAW guidelines and STRAW + 10, an update based on the review of research done in the 10 years since the original guidelines were published. Because not all of us have reached menopause, defined as one year without menstruating, some of us are interested in what we can learn from the detailed phases!

For context, remember that STRAW draws three large phases: reproductive, menopausal transition, and post-menopausal. The recent review and enhancement of the model outlined four specific stages within that “menopausal transition” that has many of us looking for answers.

During Late Reproductive Years, your ability to have a child is declining. Your menstrual cycles may be shorter and either lighter or heavier. During the first week of your cycle, the follicle-stimulating hormone may rise more than before as your body works to continue reproduction. The length of this stage varies a lot, but it could be as much as nine years.

Perimenopause officially begins with the second stage, Early Menopausal Transition. During this stage, you’ll see more unpredictability in your menstrual cycle—you may even think it’s not predictable at all! And because your body is producing more estrogen but less progesterone, you may see an increase in PMS symptoms like irritability and bloating. This stage can last four years or longer.

Late Menopausal Transition is the second “half” of perimenopause (I put “half” in quote marks because it’s probably shorter than the first stage—a year up to a couple of years). This is when you’re likely to experience the “typical” symptoms associated with menopause: hot flashes, difficulty sleeping, and mood changes. You may not have a period for a couple of months. At this point, the big trend line for hormones is a decline, but both estrogen and progesterone production can vary wildly from day to day.

Finally, you reach Early Postmenopause. Again, this is marked by a full year without a period. If you haven’t already experienced hot flashes and other menopausal symptoms, you may now, or they may be worse for a while. Because estrogen and progesterone levels are very low, this is when other symptoms become apparent, like vaginal dryness or thinning of vaginal tissues.

As I’ve said before, there’s no clear roadmap that’s infallible for every one of us. I understand, though, the desire to understand what’s happening and to try to predict what lies ahead. I have a friend who’s 56 and still, by the STRAW + 10 stage definition, in “late reproductive years”; by the guidelines, she could be 69 before she reaches menopause. Can that be true? My medical equipment doesn’t include a crystal ball!

But not having a precise roadmap doesn’t change my recommendation to all of us: Learn about what lies ahead, whether it happens fast or slow, early or late. Do what you can to compensate for or manage the changes in your body as you’re aware of them, just as you pick up your reading glasses more often when the menus are hard to read. And, because it’s true that as hormones decline, we “use it or lose it,” stay as sexually active as you choose to be. It’s good for your health, it’s good for your relationship, and it’s good for your self-image.

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About ten years ago, a group of medical professionals put their heads together to create a set of guidelines that would chart the course of normal menopause in a more systematic way. They came up with a series of three stages that were each divided into several phases that women normally experience during menopause. These were the reproductive stage, which contained three phases; the menopausal transition, which contained two phases; the postmenopausal stage, which contained two phases.

The stages were determined by the changes that normally occur in a woman’s menstrual cycle and by follicle-stimulating hormone (FSH) levels. (Read this MiddlesexMD blog post for more information about FSH.)

Each phase was given a number, from -5 for the early reproductive phase, in which a woman has regular menses but increasing FSH levels, to +2 for late postmenopausal phase, in which menstruation has completely stopped.

This diagnostic system is called the Stages of Reproductive Aging Workshop, or STRAW, and it’s been a widely used tool for further research. But clinicians have also found it useful as a roadmap for normal menopause—to determine where a woman is in the transition and to predict the course ahead.

Physicians felt that some sort of system was important because menopause marks such a significant change in a woman’s health and quality of life. Some of these changes are temporary (sleep disturbances, hot flashes), and others, such as changes in bone density and urogenital symptoms, are permanent. Given the importance of this transition, some guideline that outlines a normal course through menopause might help in making healthcare decisions about issues like contraception and hormone replacement.

“When women have an awareness of their progress during the shifting manifestations of natural aging, it can be very reassuring,” says Dr. Cynthia Steunkel at the University of California, San Diego, for an article in Menopause.

While helpful for “normal” menopause, however, the original STRAW guidelines specifically exclude women who smoke, are obese, engage in strenuous exercise, have had a hysterectomy, have a significant illness, such as AIDS or cancer, or who have chronic menstrual irregularities. It also fails to address possible differences due to ethnicity, age, and lifestyle.

In 2011, ten years after the first conference, the group reconvened to update the guidelines to take into account the significant body of new research that has emerged and to broaden the subgroups of women for whom the guidelines would apply. The updated guidelines that resulted from this latest review of the research is called STRAW + 10.

Specifically, the updated staging system includes new measures of specific hormones and other “biomarkers” that help to determine the stages of menopause. It added three new subphases that further define the late reproductive and postmenopausal stages. And it can be applied to “most women,” regardless of lifestyle and ethnic diversity, although some exceptions still apply for issues like ovarian failure and chronic illness.

Despite all the fancy testing and technology, however, the most dependable indicator of the stage of menopause is, still, a woman’s menstrual cycle. “…The menstrual cycle remains the single best way to estimate where a woman is along the reproductive path,” said Dr. Margery Gass, one of the coauthors of the new criteria and the executive director of the North American Menopause Society.

In fact, all those other tests for biomarkers are considered “supportive,” and because of the expense of testing and the need for additional research, they aren’t normally called for. I don’t recommend testing for FSH or other biomarkers, either. The tests just aren’t helpful enough.

The new STRAW + 10 guidelines fills in some gaps left by the original system and gives us all a clearer roadmap (which I’ll detail in another blog post), but since it relies mainly on the menstrual cycle to determine the course of menopause, your best bet, as I said before, is to tune into your body and work to make peace with the changes you’re experiencing. You’re not alone! We’re here to help.

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The changes that come at midlife sometimes mean that we need to recognize that we’ve fallen in a rut—whether in our health habits, relationships, or sex lives. Mary Jo Rapini, a MiddlesexMD advisor and psychotherapist specializing in intimacy and relationships, offers this advice to recognizing—and then climbing out of—those ruts.

And the day came when the risk to remain tight in a bud was more painful than the risk it took to blossom.”

–Anais Nin

I believe people can change. It isn’t easy, and most of us don’t want to, but we can. To change is difficult work, and many times it happens only when we are faced with dire consequences. People come to therapy to change. Many times they think they are coming to change someone else or get validated for why they feel the way they do. Those are all good reasons to seek therapy, but the bottom line is if you go to therapy and stick with it, you will change.

Sometimes people become afraid of the change, and they drop out of therapy; they’re often the ones who say therapy wasn’t helping them. Sometimes the patient/therapist relationship just isn’t working, but usually the key factor is whether the patient is ready to look at herself honestly and make changes that will help her to feel better about her situation and herself.

The word that most signifies resistance to making changes is but. When I hear a “but” in a session, I make note of it. I can tell where the walls are by listening for this word. Many people use this word as a way of staying stuck. There is safety in staying stuck; you know your own rut best. It may be a rut, and you may want out, but it’s scary that you don’t know what is outside your rut. Just admitting you’re in a rut isn’t easy.

A professor of mine once told me that we all live in a rut. He likened it to a distorted reality; we all make our own world, and we begin to believe it. This thought comforts me, and I think it has a lot of truth. Except humans are incredible and, once they see that there could be a better way, they will usually strive for it.

For example, if a woman is told all of her life that she is ugly, she will believe it, staying in a rut created by her family. Then someone special comes along and tells her, “You aren’t ugly, you’re beautiful.” She sees a light in her rut, and she will strive to climb up and take a step. It won’t be easy, but she will eventually take the step out. As she comes out of her rut, she will be expected to act like the confident attractive person she was told she was. At this point she can either accept the challenge or say, “But I can’t. I am ugly.” If she goes back to this thinking, the rut begins pulling her back in. Unless she hangs on to something stronger than the pull of the rut, she will slide back in. The strongest thing to hold onto is her own self worth, but what if that was taken from her at a time she was too vulnerable to fight for it? If she has no or little self worth, the rut becomes attractive again. Known pain is more comfortable than ambiguity of not knowing and anticipating pain.

Here are three things you can do on your own to identify and begin to climb out of a rut:

  1. Identify the rut you are in, who is responsible, and what you may lose if you dig out.
  2. Write down every reason you think you should stay in your rut. Many times what sabotages people is that they weren’t honest about what staying in the rut offered protection from.
  3. What do you expect will happen in the next year if you don’t change your circumstance? Is the rut more painful than your image of what is outside of the rut?

We all create our life to a certain degree, and many things happen to us over which we have no control. We do have control over how we react to what we have been given. Whether we react by staying stuck in the rut or climbing out is determined by our ability to avoid the word “but” and just making the change—one step out at a time.

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The American Association of Retired Persons (AARP), the venerable group that’s always looking out for our best interests, has completed three major surveys of the sexual behavior of midlife (and older) adults.

This third such survey was released in 2009 (following earlier surveys in 1999 and 2004), and while nothing was truly shocking, some information was interesting, and some might be helpful. And, with three such studies conducted over a period of years, the organization is able to identify some trends and changes.

The 2009 study surveyed 1670 adults (the “panel”) over the age of 45. According to the firm commissioned to conduct the study, it’s “the first online research panel that is representative of the entire U.S. population.”

So, what’s happening behind our bedroom doors?

Gender differences

It’s no news flash that men and women are different in the way they view sex. For one thing, Mars thinks about sex more than Venus. (Men are five times more likely than women to think about sex once a day). They masturbate more (34 percent to 12 percent) and admit to having oral sex more. (Presumably with women? So… are the women just too timid to admit it?) They are also twice as likely to have sex outside their long-term relationship (21 percent of men admit to infidelity as opposed to 11 percent of women).

Bottom line: “Sex is far more important to the overall quality of life of men than women and also more critical to a good relationship.”

This doesn’t mean women don’t like sex—or think about it, or fantasize, or masturbate. It just means sex is front and center in the male brain, while it nestles cozily into a less prominent lobe in women. 

Married vs. dating

While simply having a partner increases the odds of sexual satisfaction (now there’s a news flash), being married doesn’t—necessarily. Respondents who were “partnered but unmarried”—single and dating or engaged—have sex more often and like it more than their married counterparts.

Gives those of us who are married something to work on, hey?

But having a partner, whether married or not, also seems to make a difference in the broader scheme of things. Partnered respondents reported significantly higher overall quality of life and greater sexual satisfaction than those without a partner. And, obviously, they have sex more often, too.

Sexual frequency

So here’s the news flash. According to the study, “the number one factor predicting satisfaction with one’s sex life is the frequency of sexual intercourse.” See? Use it or lose it. The more you have it, the more you like it.

You heard it here first. What are you waiting for?

Among those who have sex once a week, 84 percent are satisfied with their sex life, compared to 59 percent of those who have sex once a month and 16 percent of those who haven’t had sex in the past six months.

And how often are those Eveready bunnies doing it? Of those who have partners, 41 percent are doing the once-a-week thing and 60 percent have sex at least once a month. Partnered folks are pretty touchy-feely, too: 78 percent hug and kiss at least once a week and 64 percent caress or otherwise give a little booty squeeze (sexual touching).

For women, that whole partner business is a bit of a conundrum. As we know, demographics is not on our side, since we live about five years longer on average than men, plus men tend to partner with younger women. As we age, we are more likely to be unpartnered, with the predictable impact on our sex life.

Deterrents

In addition to being affected when we’re partnerless, sex is, of course, exquisitely sensitive to other events in our lives. The major life events that impact sexual frequency and satisfaction are health, stress, and financial worries (a different kind of stress, no?).

Good health is a top predictor of sexual frequency and satisfaction in many surveys. In this one, of those who rated themselves in “excellent” health, 42 percent have sex at least once a week and 54 percent are satisfied. Of those in fair health, 19 percent have sex once a week, and 23 percent are satisfied.

And while good health is partly the result of good genes and good luck, it’s also strongly related to good habits. The most active respondents—those who report exercising at least 3 to 5 times weekly—also rate themselves in excellent to good health.

Stress “is a major factor in sexual satisfaction,” especially among the youngest respondents. After age 60, respondents tend to experience lower stress levels. So, while younger people tend to be more sexually active, the study’s authors hypothesize that they might be even more so if they were less stressed.

The economic crisis and its attendant financial uncertainties may account for lower levels of sexual frequency and satisfaction, which were a full ten points lower than the 2004 survey.

From the mass of data they collected, the study’s authors compiled a short list of qualities that are good predictors of a happy sex life. They are:

  • a partner
  • frequent sex
  • good health
  • low stress levels
  • lack of financial worries

Whether you’re a tortoise or a hare on the sex scale, remember that studies like these are only for information; they aren’t meant to pigeonhole or categorize. Your sex life and habits are unique to you and your partner. If sex is pleasurable and satisfying for both of you, who cares how often you “do it”? And if you find yourself dissatisfied and frustrated, well, this is one area in which improvement is always possible.

If you want to read the full report, you can find it here.

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